Center for TB Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
PLoS One. 2013 Apr 17;8(4):e62211. doi: 10.1371/journal.pone.0062211. Print 2013.
Symptom screening is a recommended component of intensified case-finding (ICF) for pulmonary tuberculosis (TB) among HIV-infected individuals. Symptomatic individuals are further investigated to either exclude or diagnose pulmonary TB, thus reducing the number of individuals requiring costly laboratory investigation. Those with laboratory evaluations negative for pulmonary TB or who lack symptoms may be eligible for antiretroviral therapy (ART) and/or TB isoniazid preventive therapy (IPT). A four-part symptom screen has been recommended by the World Health Organization (WHO) for identifying TB suspects and those unlikely to have TB. A meta-analysis of studies among HIV-infected individuals calculated a sensitivity of 90.1% for the four-part symptoms screen--of any of cough, fever, night sweats, or weight loss--among patients in clinical care, making it an effective tool for identifying most patients with TB. An important population for intensified case-finding not included in that meta-analysis was HIV-infected pregnant women. We undertook a cross-sectional survey among HIV-infected pregnant women receiving prenatal care at community clinics in South Africa. We obtained a four-symptom review and sputum smear microscopy and mycobacterial culture on all participants. Among 1415 women, 226 (16%) had a positive symptom screen, and 35 (2.5%) were newly diagnosed with culture-positive TB. Twelve were on TB treatment at the time of screening, yielding 47 (3.3%) women with prevalent TB. Symptom screening among women without known TB had a sensitivity of 28% and specificity of 84%. The poor performance of symptom screening to identify women with TB suggests that other approaches may be needed for intensified case-finding to be effective for this population.
症状筛查是针对感染 HIV 的个体进行强化病例发现（ICF）的推荐组成部分，用于筛查肺结核（TB）。有症状的个体将进一步进行调查，以排除或诊断肺结核，从而减少需要昂贵实验室检查的个体数量。那些实验室检查结果排除肺结核或缺乏症状的个体可能有资格接受抗逆转录病毒治疗（ART）和/或异烟肼预防性治疗（IPT）。世界卫生组织（WHO）推荐了一个四部分症状筛查，用于识别结核病疑似患者和不太可能患有结核病的患者。一项针对 HIV 感染者的研究荟萃分析计算出，在临床护理中的患者中，任何一种症状（咳嗽、发热、盗汗或体重减轻）的四部分症状筛查的敏感性为 90.1%，这是一种识别大多数结核病患者的有效工具。该荟萃分析未包括的一个强化病例发现的重要人群是感染 HIV 的孕妇。我们在南非社区诊所接受产前护理的 HIV 感染孕妇中进行了一项横断面调查。我们对所有参与者进行了四项症状回顾、痰涂片显微镜检查和分枝杆菌培养。在 1415 名女性中，226 名（16%）有阳性症状筛查，35 名（2.5%）新诊断为培养阳性结核病。12 名在筛查时正在接受结核病治疗，因此有 47 名（3.3%）女性患有现患结核病。在没有已知结核病的女性中，症状筛查的敏感性为 28%，特异性为 84%。症状筛查识别结核病女性的表现不佳表明，对于这一人群，可能需要其他方法来进行强化病例发现，以提高其效果。
